NYC 9/11 Public Portal Document
Westchester
gov.com
ENVIRONMENTAL SERVICES SAMPLESUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
Date Set:
NYS-ELAP No. 10108
Form A-70 (rev. 1/96)
Sample Type (circle one):
1) Potable
3. Non Potable Treated
2. Non Potable*
4. Other
Time/Date Collected: 9 2a0
Collected By: wagnet
Collected From:
Location's/Individual's Name_NVC.
Street
WOSEa VoNr.
City/St/Zip
Vainalia
NV
Identification of Source
Collection Point LaT Lelt
Agency Code:
Sc O
Kix a RiERe- 0183
G 92:2 CFC- 128. 0 1330
18281.K-7211
Bottle #'s: C03i2 GFB 1254 P-4039 1 3i5, 9132013
Chain of Custody? yes
Comments:
PWS#:
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#t:
Fax#:
CA,CH, BI?
Check#:
Amount$_
BACTERIOLOGICAL ANALYSIS
ORGANIC POTABLE ANALYSIS
ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab#:
(circle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2. Coliform P/A (public supplies)
3. Coliform MPN (priv well, raw, stp)
4. Fecal Coliform (all samples)
5. Microscopic
6. Macroscopic
8. Other:
Refrigerated?
yes
Chlorinated:2 yes no
Free Chlorine Res:
Total Chlorine Res:
2no
mg/L
mg/L
pH
Lab#:
(circle tests)
1. Trihalomethanes (524)
Volatile Halocarbons (524)
3/ Volatile Aromatics (524)
4
Total Trihalomethane Potential (510)
5.
Microextractables (504)
6.
Pesticides (507)
7
Pesticides/PCB screen (508)
8. PCB as Decachlorobiphenyl(508A)
9. Herbicides (515)
10
Pesticides (525)
11. Carbamate Pesticides (531)
12. Glyphosate (547)
13. Diquat (549)
14. Chlorination Disinfection Byproducts (551)
15. Haloacetic Acids (552)
16. Pesticides (SM18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
18. Other:
1 Purgeable Halocarbons (624/8260)
2. Purgeable Aromatics (624/8260)
3. Acrolein & Acrylonitrile (624)
4. Phthalates (625/8270)
5. Organochlorine Pesticides (608/8081)
6. PCB's (Arochlors) (608/8081)
7. Methoprene (616)
8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
10. Petroleum Hydrocarbon Scan (310-13)
11. Glycols
12. Acid Extractables (625/8270)
13. Base Neutral Extractables (625/8270)
14/ GC/MS Semivolatile Unknown Scan
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's (DEF)
18. Other:
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
1. Color
2. Turbidity
3. pH
4. Conductivity
5. Corrosivity (temp:
°C)
6. BOD (5 day)
7. Soluble BOD (5 day)
8. Carbonaceous BOD (5 day)
9. Chemical Oxygen Demand
10. Dissolved Oxygen
11. Total Organic Carbon
12 Total Organic Halides
13. Solids, Percent (%)
Solids, Settleable
Solids, Suspended
16. Solids, Total
17. Solids, Total Dissolved
18. Solids, Total Volatile
19 Other:350.1
20. Acidity
21. Alkalinity, as CaCO3
22 Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO3
28. Nitrogen, Ammonia as N
29. Nitrogen, Nitrate as N
30. Nitrogen, Nitrite as N
31. Nitrogen, Total Kjeldahl as N
32. Oil an Grease
33. Phenol
34. Phosphorus Total as P
35. Phosphorus, Ortho as P
36. Sulfates
37. Surfactants
38. UV254
39. Aluminum
nulas
59. Potassium
40, Antimony
60. Selenium
41. Arsenic
61. Silver
42. Barium
62. Sodium
43/Beryllium
63. Thallium
44. Boron
64. Vanadium
45. Cadmium
65. Zinc
46. Calcium, as cacos
CLP
47. Calcium, Ca*2
66. Metals/CN
48. Chromium, Total
67. Volatiles
49. Chromium, Hexavalent
68. Semi-violatiles
50.Cobalt
69. Pesticides/PCB's
51. Copper
70. Disk Deliverables
52, Iron
53.Lead
TCLP
54 Magnesium
71.TCLP-Metals
72. TCLP-Pesticides
55 Manganese
56. Mercury
73. TCLP-Herbicides
74. TCLP-Volatiles
57 Molybdenum
58. Nickel
75. TCLP-BNAS
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